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Original Article
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Volume 346:469-475 February 14, 2002 Number 7
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Pure Red-Cell Aplasia and Antierythropoietin Antibodies in Patients Treated with Recombinant Erythropoietin
Nicole Casadevall, M.D., Joelle Nataf, M.D., Béatrice Viron, M.D., Amir Kolta, M.D., Jean-Jacques Kiladjian, M.D., Philippe Martin-Dupont, M.D., Patrick Michaud, M.D., Thomas Papo, M.D., Valérie Ugo, M.D., Irène Teyssandier, B.S., Bruno Varet, M.D., and Patrick Mayeux, Ph.D.

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ABSTRACT

Background Within a period of three years, we identified 13 patients in whom pure red-cell aplasia developed during treatment with recombinant human erythropoietin (epoetin). We investigated whether there was an immunologic basis for the anemia in these patients.

Methods Serum samples from the 13 patients with pure red-cell aplasia were tested for neutralizing antibodies that could inhibit erythroid-colony formation by normal bone marrow cells in vitro. The presence of antierythropoietin antibodies was identified by means of binding assays with the use of radiolabeled intact, deglycosylated, or denatured epoetin.

Results Serum from all 13 patients blocked the formation of erythroid colonies by normal bone marrow cells. The inhibition was reversed by epoetin. Antibodies from 12 of the 13 patients bound only conformational epitopes in the protein moiety of epoetin; serum from the remaining patient bound to both conformational and linear epitopes in erythropoietin. In all the patients, the antibody titer slowly decreased after the discontinuation of treatment with epoetin.

Conclusions Neutralizing antierythropoietin antibodies and pure red-cell aplasia can develop in patients with the anemia of chronic renal failure during treatment with epoetin.


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From the Departments of Hematology (N.C., V.U., I.T.) and Nuclear Medicine (J.N.), Hotel-Dieu, Paris; INSERM Unité 362, Paris (N.C., V.U., I.T.); the Departments of Nephrology (B. Viron) and Internal Medicine (T.P.), Hôpital Bichat, Paris; Association pour l'Utilisation du Rein Artificiel dans la Region Parisienne, Saint Ouen (A.K.); the Department of Hematology, Hôpital Beaujon, Clichy (J.-J.K.); Centre de Traitement des Maladies Rénales Saint Augustin, Bordeaux (P.M.-D.); Polyclinique de Lagny, Lagny-sur-Marne (P. Michaud); the Department of Hematology, Centre Hospitalier Universitaire Necker–Enfants Malades, Paris V University, Paris (B. Varet); and the Department of Hematology and INSERM Unité 363, Institut Cochin de Génétique Moléculaire, Paris (P. Mayeux) — all in France.

Address reprint requests to Dr. Casadevall at Hotel-Dieu, 75181 Paris CEDEX 04, France, or at nicole.casadevall{at}htd.ap-hop-paris.fr.

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Related Letters:

Pure Red-Cell Aplasia and Recombinant Erythropoietin
Gershon S. K., Luksenburg H., Coté T. R., Braun M. M., Sokol L., Prchal J. T., Casadevall N., Mayeux P., Bunn H. F.
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N Engl J Med 2002; 346:1584-1586, May 16, 2002. Correspondence

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